P1272 SellDAVIE COUNTY HEALTH D P,ARTMENT SEPTIC TANK PERMIT ate
JHmer/Occupant To:
61
Address914.1, ' /Zc.`� `�_j , _ Address a
Building Contractor Address
Cal. Manufactur is Name Address
No. of lines �_ WidthZ in. Total length ft. No. sq. ft.
Type of filter material"•-, Total tons used (2l"'
Hinimum REquirements: Houset0ailer Tank cap. ...800 Sq. ft. line 400
Two-bedroom house 806 600
Three-bedroom house 900 900
No one shall install a septic tank in Davie County without a permit from the Health Offic
or his agent. _
Date of Final Approval Signed:
Sanitarian
I hereby certify that the above septic tank has been installed acc rding to specification
Y19
Signed:S c Ta o act
I
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.
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